| NPI | 1194180596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA060025) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004227) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2018-09-18 |